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Stroke

How Is A Stroke Treated?

Tuesday, April 24, 2012 - 16:51

Contributing Author: Guy Slowik FRCS

A stroke is a medical emergency, regardless of whether it is a major stroke or a short-lasting TIA. A person suffering a stroke should be taken immediately to a hospital emergency department.

The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is critically important in treatment decisions. A stroke caused by a blocked artery is treated in an entirely different way than a stroke caused by bleeding within the brain.

The key to survival and recovery is prompt medical treatment.

How-To Information:

If a stroke is caused by a blocked artery, medications are now available to reverse damage to the brain and significantly increase the odds of survival. However, these medications are effective only if they are given within a few hours of the time when the first stroke symptoms begin.

Tests That May Be Performed At The Hospital

Scans of the brain are performed to confirm a diagnosis of stroke and to determine the type of stroke. This is important since the treatment of different types of stroke differs.

These tests include:

  • Computed tomography scan (CT scan) is generally the first diagnostic test done after a person suspected of having a stroke arrives in the emergency department. The test uses low-dose x-rays to take pictures of the inside of the brain.

    For more information about CT Scan, go to Computed tomography scan (CT scan).

  • Magnetic resonance imaging (MRI) is an advanced diagnostic tool that uses the principals of magnetism to view the inner body. An MRI of the brain can show small blood vessels that may be blocked or bleeding.

    For more information about MRI, go to Magnetic resonance imaging (MRI).

  • Transcranial doppler (TCD) is a new, noninvasive ultrasound procedure that uses a small probe placed against the skull to track the blood flow through the vessels in the brain.
  • SPECT imaging uses low doses of a harmless radioactive substance injected into a vein in the arm, then uses a specialized camera to view the blood flow in the brain.

Medicines To Treat Stroke

If the stroke is caused by a blockage:

  • Drug therapy is a relatively recent approach to the treatment of stroke. If the stroke is caused by a blockage in an artery, medications called thrombolytic drugs can be used. The only drugs approved by the FDA for treatment of stroke are tissue plasminogen activators (TPA drugs). Popularly referred to as "clot-busting" drugs, these medications have been used for years to treat heart attacks.

    Some studies have indicated that if TPA drugs are given to stroke patients within three hours of the onset of symptoms, more than half of them will make a full recovery in a matter of months.

    Not all hospitals, however, have the ability to give TPA drugs to people having a stroke. Before these drugs can be given, doctors must be certain that the stroke is the result of a blockage in the artery and not due to bleeding from an artery. This is determined through imaging procedures such as computed tomography (CT) scans and magnetic resonance imaging (MRI). But not all hospitals have around-the-clock imaging services.

If a stroke is caused by bleeding:

  • Medication can be given to reduce swelling of brain tissue.

Surgical Procedures

If the stroke is caused by a blockage:

A procedure called carotid endarterectomy can be used to remove a buildup of plaque from inside the carotid artery, one of the major sources of blood to the head and neck. Carotid endarterectomy can be used to treat people who have had a stroke and also as a preventive measure for people at risk for stroke.

If the stroke is caused by bleeding:

  • An artery within the brain sometimes can be "clipped" to prevent further bleeding.
  • If the bleeding has occurred in the subarachnoid space, pooled blood (hematoma) can dangerously increase pressure on the brain and damage delicate tissue. If it is feasible, surgery may be necessary to drain blood from within the area of damaged brain tissue.

Other Procedures

Several types of interventional radiology also are available to treat stroke. These procedures have been in existence for some time, but they have been improved and refined in recent years. However, not all hospitals are equipped to offer interventional radiology.

Interventional radiology is performed by inserting a long, thin, flexible tube called a catheter into blood vessels. The insertion point is usually in the groin, and the incision is about the size of the tip of a pencil. The catheter is guided to various parts of the body while a computer tracks it and records images of the blood vessels. This procedure creates a precise road map of even the tiniest vessel in the body.

  • The catheters can be guided to areas of bleeding and used to effectively close off the leaking vessels.
  • The catheters can be used to widen areas of blood vessels that have become narrowed because of a buildup of plaque.
  • The catheters can be used to place stents made of a fine, tubular wire mesh to hold a blood vessel open.

What To Expect During A Hospital Stay

After the initial tests to determine the type of stroke and the best treatment, other procedures may be necessary to find the cause of the stroke. These procedures may include tests of the heart or the arteries to the brain.

The length of the stay in the hospital and the type of treatment will depend on the severity of the stroke. Many people need some form of therapy to help their brain relearn skills lost because of the stroke.

Nice To Know:

Q: My father had all the signs of a stroke, but he waited more than six hours before getting to the hospital. Even though his stroke was caused by a blocked artery, doctors did not give him "clot-busting" medicines. Why not?

A: TPA drugs are powerful blood thinners that can help dissolve a clot and restore blood flow, but the FDA requires that they be given within three hours after stroke symptoms first begin. When TPA is given more than three hours after stroke onset, there is a greater risk that it will cause uncontrollable bleeding. It is very important that this guideline is followed and that everyone is made aware of the critical importance of seeking help immediately if experiencing stroke symptoms.

Stroke